Medical Contact Center Representative, Inbound and Outbound
$41,600–$45,760 year
RemoteUnited States
Job Summary
Provide friendly, accurate, and timely service to customers via phone, email, chat, SMS, video calls, and co-browser sessions. Actively listen to understand needs, navigate internal processes, and resolve complex issues regarding benefits, claims, eligibility, and prior authorizations. Conduct outbound enrollment outreach, clinical quality calls, and wellness check-ins including medication refill reminders and preventive care notifications. Educate customers on plan benefits, explain complex healthcare information clearly, and empower them to use self-service portals. Protect customer privacy and comply with HIPAA, TCPA, and all applicable regulations while documenting interactions accurately. Backup and support departments such as Claims, Intake, and Care Management as needed. Meet performance goals related to customer satisfaction, first contact resolution, and outreach productivity.
Required Qualifications
- High school diploma or equivalent
- Minimum of 2 years of experience in one or more of the following: customer service in a health plan, HMO, TPA, or healthcare setting; OR program enrollment, telemarketing, cold calling, appointment setting, inside sales, or other outbound calling roles
- Minimum of 1 year of experience in a healthcare contact center or outbound calling environment
- Exceptional, demonstrated customer service skills, with a genuine passion for helping others
- Strong empathy, patience, and the ability to build rapport with diverse individuals
- Excellent verbal and written communication skills, excellent grammar, and pronunciation in the English language
- Ability to communicate clearly, concisely, and professionally
- Active listening skills and the ability to understand and address customer needs effectively
- Strong persuasion and objection-handling skills, with the ability to articulate the value of programs and services in a clear, Customer-centered way
- Comfort with structured outbound calling, scripted call flows, and dialer-based workflows
- Resilience and a positive, professional attitude when navigating refusals, voicemails, unanswered calls, and repetitive dialing volume
- Strong problem-solving and critical-thinking abilities
- Ability to navigate complex systems and processes
- Proficiency with computer systems, including CRM software and Microsoft Office Suite
- Ability to learn and retain information quickly
- Ability to work independently and as part of a team; must possess a high level of accountability for your work and in support of the team and the business
- Ability to handle stressful situations with professionalism and composure
- Knowledge of medical terminology, healthcare benefits, and insurance processes
Desired Qualifications
- Candidates with experience in both inbound and outbound Customer service via multiple channels
- Bilingual skills
- Associate's, bachelor's or master's degree
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